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Wednesday, 30 January 2013

Clinical Practice, Melody and Harmony

Clinical Practice, Melody
and Harmony

Music is an art that is given form by its characteristics including
melody, harmony, rhythm, texture, dynamics and pitch coming together.

There is evidence both the 7-note diatonic scale (melody) as
well as harmony existed 3400 years ago as seen in the Syrian city Ugarit
tablets. Though in earlier times there was probably no formatted succession as
musical melody of any sort. In musical development, a sense for
"melody" would not have occurred overnight as music often was the
playing of single notes, assigned to various rituals, such as one gong for
moon, another for sun, another for death, birth, etc.

Every piece of music has its own DNA, made up of three
elements: melody, harmony and rhythm; present in every popular song from every
genre. Melody is defined as the soul of music can stand alone; the addition of
harmony gives music its beauty and adds detail thus catching the listeners'
attention.

One of the music explorers of the 20th century, Alan
Hovhaness, once said that the compose joins Heaven and Earth with threads of sound
which combine the melodic lines and
harmony. They are the two necessary elements to music.

MELODIC SYSTEM

Melody is defined as the primary sequence of notes or
successive line of single tones or pitches perceived as a unity forming
passages or phrases in various patterns leading to a song with the
characteristics such as range, shape, pitch and movement. Movement of a melody
or melody line is the direction or shape or the geometric line made when notes
are joined together. When the melody moves stepwise and is connected, the
movement is termed conjunct. Melody that leaps from pitch to pitch with no
natural connection or flow is said to be disjunct.

In melodic music, normally there are one or two 'leads' who
sing or play the melody. Music forms such as country, rock, Hindustani and
Carnatic are examples of melodic forms of music. Hip-hop, rap, reciting verses,
reciting slokas can also be considered a version of melodic music.

In melodic system of music there is a greater freedom to improvise and almost no two artistes are
likely to perform the same song/music in a similar manner neither would they wish
to do so.

HARMONIC SYSTEM

Harmony is defined as the secondary series of a particular
sequence of notes or chords (a group of 3 notes played together or in a
separate manner one after another) which occur simultaneously with the melody. Harmony
is the relation of notes to notes and chords to chords as they are played
simultaneously.

The harmony of a song always has a different series of notes
from the melody, although sometimes when the harmony is played simultaneously
with the harmony the notes in both may be the same briefly.

In harmonic musical systems very frequently there are 'lead'
instruments which play melodies but are at the same time accompanied often by a
large group of other instrumental musicians playing something different from
the 'lead' at the same time. The relationship between different notes played
at the same time is what is called harmony. When two singers or
instrumentalists are playing the same notes instead of harmonizing notes, they
are no longer harmonizing but instead said to be playing "in unison"
or together.

Western classical music is from the same script whenever and
where ever it is played. Of course there is improvisation and indeed there are
differences between various orchestras and it results in great music but one
that matches the script/notes.

Melody and Harmony

Melody and harmony are considered as the body and soul of
music. We do not forget the importance of rhythm and tone that are built into the
writing thus making music.

Melody is the linear aspect of music, in contrast to
harmony, the chordal aspect, which results from the simultaneous sounding of
tones. Harmony's function has evolved mostly to make the notes of melodies
"connect" or to make their connection to each other melodically more
apparent to the ear. It is a result of the joint contribution of melody and
harmony in which the listener is “directed to a single melodic line, but this
is conceived in relation to harmony”

While the melodic constraint is nearly universal, the
harmonic constraint is more particularly Western. Many non-Western styles either reject chords
altogether, using only one note at a time or build entire pieces around a
single unchanging harmony.

Doctors in melodic form

It will be apparent by now that most doctors who are trained
as 'individuals' with high knowledge to be able to deliver 'independent' care
supported by a few other individuals in small teams (units, firms, etc) are
probably in the melodic form. The 'attending' or the 'consultant' is the 'lead'
and will deliver care 'tailored' to the patient (improvisation) and often no
two individual clinicians would ever do or want to provide the exact same care
even when faced with similar situations. They do deliver great care.

This has recognition with rock stars and rock bands. There
is usually a lead singer and a lead guitarist often both are the same person, supported
by a very small team of rhythm, base, keyboard and drums. They make great
music. Those who are familiar with the Indian systems of Carnatic or Hindustani
music will easily recognise the similarity with one (rarely two) lead expert
singer/musician supported often by just two other musicians (an instrumentalist
and a rhythm player). They make great music.

Healthcare delivery systems
are harmonic

Most of us will also recognise
that the days of individual clinical experts practising independently in their
own premises is over in many countries such as UK when the NHS was created and
on the way out in many countries such as USA (with HMOs and other attempts) and
India (with corporate sector multi-specialty large hospitals). The practise of
medicine has become too complex and sadly too costly for the continuation of
the purely 'melodic' practice of individuals however brilliant they may be due
to the need to avoid disjuncts.

What might be happening now is
that we have put 'melodic' practitioners all together on a harmonic platform
and expect harmony. What we get is occasional 'unison' and not harmony. The
'unison' can sound good too as when top musicians perform on the same stage as
a tribute to someone or on some occasion. South Indians will recognise the
Thyagaraja Aradhana where individual melodic monarchs sing in unison but that
should not be mistaken or harmony. Similarly, we have individuals with the
training and ability to practice independently all under one roof, occasionally
there is unison, often there is cacophony. Hopefully this will be a
transitional phenomenon.

This is where leadership comes in.
Healthcare employers should be explicit in defining that healthcare delivery is
now in overall harmonic mode with the melodic element as a vital element. Conductors
(Chief Execs, Medical Directors, Nursing Directors, Clinical Directors, et al)
should ensure that doctors and other clinicians work in an harmony mode where
every individual within the team/orchestra follows a script (evidence,
especially operational evidence that has prior local agreement) that is
specific for that song/music and though it does not match with other musicians
in an exact manner and though there is some degree of improvisation to cater to
the situation (variation as a result of patient based differences). The
resulting output will be greater care than we are able to offer today. Hence our belief is that doctors and
clinicians may be better working in a harmony mode.

Melody by itself (monophonic music) was the principal form
of composition in western cultures before the year 1000. Together these
constraints ensure a two-dimensional coherence in Western music analogous to
that of a woven cloth. The classical western music has now moved on to harmony.
It is time for healthcare to move from the melody of individual brilliance to
the harmony of collective success.

Geetha Upadhyaya is CEO and Artistic Director at Kala Sangam. She was a
Consultant Pathologist, with a particulat interest in the health
benefits of practising arts. Having a postgraduate degree in classical
Indian dance and music, her main interests are cross art collaborations,
choreography and music. Geetha's aim is to establish Kala Sangam at St
Peter's House as a national centre for South Asian arts, heritage and
culture.

Geetha's thoughts expressed in this blog post
are her own personal views and does not represent any organisation.

your blog caught my attention since it used music terms 'harmony' and 'melody'. I have great interest and some little knowledge of music and even in our melodic system (Carnatic), when male and female singers sing in the same 'shruthi', they are actually singing at different octaves, so in effect, it's a melodic harmony! This applies for most duets and the mass singing during the Thyagaraja aradhana festival in Thiruvaiyaru. The mridangam and Tabla (amazing percussion instruments which are tuned to the shruthi,)are not always tuned to 'shadjam', so this also constitutes harmony. So the music is the same, it's the prayogam which is different. The Tanpura which can have sa, pa, sa or sa, ma, sa is also a harmonic instrument though the notes are played one by one (the effect is orchestral). It's quite common in Violin to play two strings at the same time which is almost like a chord (Kunnakkudi's playing often has this effect)